Background
The extensive mesenteric lymphadenopathy associated with midgut carcinoids often causes
lymphatic obstruction and leads to the development of alternative lymphatic drainage
pathways. We hypothesized that altered lymphatic drainage makes traditional determination
of resection margins inadequate.
Methods
One hundred and seventy patients underwent cytoreductive surgery for neuroendocrine
tumors from November 2006 to August 2008. Forty-nine patients underwent intra-operative
lymphatic mapping with lymphazurin dye as a single agent. Twenty-seven patients had
midgut primaries. We reviewed operative findings and pathology to evaluate the safety
and efficacy of lymphatic mapping for midgut carcinoids. Lymphatic mapping defined
resection margins were compared to traditional surgical margins.
Results
There were no adverse events associated with the 49 lymphatic mapping procedures.
Twenty-five (92%) patients had ileal and 2 had jejunal primaries. Lymphatic mapping
changed traditional resection margins in 88% of patients. We preserved the ileocecal
valve in 6 of 15 (40%) of patients with terminal ileal primaries.
Conclusion
Lymphatic mapping seems to be a safe, time efficient, and effective way to determine
adequate resection margins for midgut carcinoids. We advocate using lymphatic mapping
for patients with midgut carcinoids to identify adequate resection margins and assist
in preservation of the ileocecal valve in patients with terminal ileal primary carcinoids.
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Article info
Publication history
Accepted:
September 17,
2009
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
